Adult Eating Disorders
I understand that eating disorders cannot be explained simply, nor is the remedy predictable, therefore, there is the need for a multipronged focus. I understand too that nobody chooses to develop an eating disorder; eating disorders are a complex phenomenon, and have usually developed in response complex issues and dilemmas, and for any number of reasons. Many of the symptoms of an eating disorder can be experienced as desirable, such as loss/controlling of weight, numbing of emotions, feeling in control, receiving positive feedback from peers and society for restraint and self-control, changes in family dynamics, and a myriad of other reasons, and which also make eating disorders very difficult to give up. With this in mind we also work to evaluate, understand and enhance your motivation for change.
Together, we take some time to develop a comprehensive understanding of the problem, incorporating ideas about early experiences, core beliefs, triggers and maintaining factors - what the eating disorder is trying to express and what it is being used to defend against. The behaviours of an eating disorder need to be viewed alongside the environmental contributors and your individual underlying struggles – we do this because if the focus of recovery remains in too narrow a place, you are likely to experience limited success in attempts to recover. This fuller exploration is designed to help us both understand that while the eating disorder makes sense and has been of some help to you in the past, it entraps you in vicious cycles that create even more problems – our task is to generate a more adaptive and preferred approach to life’s difficulties.
From here, a treatment plan is developed – initially the plan may be to build the motivation that you will need in order to confront the hard work ahead. We are likely to engage with cognitive behavioural, interpersonal, acceptance and commitment, motivational, dialectical and psychodynamic therapies, each time, assessing which will work best for you. With each plan, we need to agree on the treatment goals and the treatment tasks.
I understand it may take some time before you are able to trust me, especially if you are going to work towards, and eventually approach, those things you have been so avidly avoiding. You may be avoiding emotions like guilt or fear, sensations such as fullness or fatness, thoughts of being fat or having had too much food, or physiological reactions such as a racing heart. Eating disorder behaviours and/or starvation will have been helping you avoid all of these things, at least in the short-term.
You may be aware, at some level, that your eating disorder is helping you avoid being confronted with some pain, such as the pain of rejection, failure, traumatic memories, fragility or criticism for example. Eating disorders, which produce numbness, are positively reinforcing because they allow one to detach from oneself from their pain and distress or believe that a pain or distress has been averted. The more numb one becomes from starvation, the more ‘pain-free’ one is. The food behaviours and starvation work so well at masking feelings that the source of original pain is often removed from conscious awareness. I also know that this numbness doesn’t mean you are emotionless, rather that your most intense feelings are redirected such that they are experienced in relation to your food behaviours or body. Thus the behaviours create a safer arena in which to experience these emotions. I understand that ultimately these numbed emotions need to be experienced safely, processed, and integrated in order for you to recover.
Together, we take some time to develop a comprehensive understanding of the problem, incorporating ideas about early experiences, core beliefs, triggers and maintaining factors - what the eating disorder is trying to express and what it is being used to defend against. The behaviours of an eating disorder need to be viewed alongside the environmental contributors and your individual underlying struggles – we do this because if the focus of recovery remains in too narrow a place, you are likely to experience limited success in attempts to recover. This fuller exploration is designed to help us both understand that while the eating disorder makes sense and has been of some help to you in the past, it entraps you in vicious cycles that create even more problems – our task is to generate a more adaptive and preferred approach to life’s difficulties.
From here, a treatment plan is developed – initially the plan may be to build the motivation that you will need in order to confront the hard work ahead. We are likely to engage with cognitive behavioural, interpersonal, acceptance and commitment, motivational, dialectical and psychodynamic therapies, each time, assessing which will work best for you. With each plan, we need to agree on the treatment goals and the treatment tasks.
I understand it may take some time before you are able to trust me, especially if you are going to work towards, and eventually approach, those things you have been so avidly avoiding. You may be avoiding emotions like guilt or fear, sensations such as fullness or fatness, thoughts of being fat or having had too much food, or physiological reactions such as a racing heart. Eating disorder behaviours and/or starvation will have been helping you avoid all of these things, at least in the short-term.
You may be aware, at some level, that your eating disorder is helping you avoid being confronted with some pain, such as the pain of rejection, failure, traumatic memories, fragility or criticism for example. Eating disorders, which produce numbness, are positively reinforcing because they allow one to detach from oneself from their pain and distress or believe that a pain or distress has been averted. The more numb one becomes from starvation, the more ‘pain-free’ one is. The food behaviours and starvation work so well at masking feelings that the source of original pain is often removed from conscious awareness. I also know that this numbness doesn’t mean you are emotionless, rather that your most intense feelings are redirected such that they are experienced in relation to your food behaviours or body. Thus the behaviours create a safer arena in which to experience these emotions. I understand that ultimately these numbed emotions need to be experienced safely, processed, and integrated in order for you to recover.
